Individual
CHARLES JAY WAISBREN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
201 N MAYFAIR RD, SUITE 510, WAUWATOSA, WI 53226-4216
(414) 771-5900
(414) 771-4908
Mailing address
201 N MAYFAIR RD, STE 510, WAUWATOSA, WI 53226-4216
(414) 771-5900
(414) 771-4908
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
25111
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
305641000
—
WI
Enumeration date
09/25/2006
Last updated
05/10/2016
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